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Turbine Powered Aircraft Insurance Application

To be completed by chief pilot or director of flight operations.

General Information:
State: Zip:
 

If "managed" aircraft, provide copy of contract/agreement between owner and operator.

Aircraft Information:

Year Make & Model FAA Number No. of Seats Insured
Value
Estimated Annual Hangared?
Pass. Crew Part 91 / Part 135
1.
2.
3.
4.
5.

Home Airport:
Runway Length :
Published Precision Instrument Approach? Explain:
Are Jet aircraft equipped with thrust reversers?: Explain:
Will any aircraft be flown for hire? Explain:
Has any aircraft been modified? Name and location of modifier:

Average Load Factors:
Aircraft #1: Aircraft #2: Aircraft #3: Aircraft #4: Aircraft #5:

Geographic areas aircraft usually operated within:
International Operations? Explain:
Any use of non-owned aircraft? Explain:
Names and locations of vendors providing the following services (including agreements if available)
Storage:
Fueling:
Airframe Maintenance:
Engine Maintenance:
Avionics Maintenance:
Has Applicant or Operator had any accidents or incidents?
Explain:

Date Insurance is to begin:
Signature of Applicant: Title:

Pilot Qualifications (List All Pilots Who Will Operate the Aircraft):

(Fill out this table for First Pilot)  
Name
Pilot or Co-pilot
Age
Pilot Certificates and Ratings
(mark Y or N)
PVT
COMM
ATP
AMEL
Instrum
Rotor
Other
Type Ratings
Logged Pilot in Command Hours
Turboprop
Jet
Rotor
Make/Model insured A/C
(Fill out this table for Second Pilot)  
Name
Pilot or Co-pilot
Age
Pilot Certificates and Ratings
(mark Y or N)
PVT
COMM
ATP
AMEL
Instrum
Rotor
Other
Type Ratings
Logged Pilot in Command Hours
Turboprop
Jet
Rotor
Make/Model insured A/C
(Fill out this table for Third Pilot)  
Name
Pilot or Co-pilot
Age
Pilot Certificates and Ratings
(mark Y or N)
PVT
COMM
ATP
AMEL
Instrum
Rotor
Other
Type Ratings
Logged Pilot in Command Hours
Turboprop
Jet
Rotor
Make/Model insured A/C
(Fill out this table for Fourth Pilot)  
Name
Pilot or Co-pilot
Age
Pilot Certificates and Ratings
(mark Y or N)
PVT
COMM
ATP
AMEL
Instrum
Rotor
Other
Type Ratings
Logged Pilot in Command Hours
Turboprop
Jet
Rotor
Make/Model insured A/C
(Fill out this table for Fifth Pilot)  
Name
Pilot or Co-pilot
Age
Pilot Certificates and Ratings
(mark Y or N)
PVT
COMM
ATP
AMEL
Instrum
Rotor
Other
Type Ratings
Logged Pilot in Command Hours
Turboprop
Jet
Rotor
Make/Model insured A/C

Does Applicant/Owner participate in formal flight training program for each insured aircraft?
Name of School:
Date last completed by each pilot:
Does school have visual flight simulator for each make and model?

Has each pilot completed manufacturer's ground school for the make and model of aircraft?

  Name Completed Date last attended
Pilot #1
Pilot #2
Pilot #3
Pilot #4
Pilot #5

Will anyone other than the pilots named above operate the Applicant's aircraft?
If Yes, Explain:
Does Applicant/Owner employ their own maintenance people?
Have the maintenance personnel completed manufacturer's maintenance course?

Loss History:

Chief Pilot is: Director of Flight Operations is:

Signature of Chief Pilot or Director of Flight Operations:

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